{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:00:02Z","timestamp":1790172002095,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Treosulfan is an alkylating agent indicated as a conditioning agent for allogeneic hematopoietic cell transplantation (HCT), with an established favorable acute toxicity profile; however, its long\u2010term sequelae remain incompletely characterized. This review aims to characterize the late effects following treosulfan\u2010based conditioning in pediatric HCT and to identify critical gaps in published evidence. This systematic review was conducted in accordance with PRISMA guidelines and prospectively registered with PROSPERO (CRD420261345072). PubMed, Embase, and the Cochrane Library were searched from inception through April 28, 2026 for studies reporting late effects in patients aged \u2264 40 years at the time of HCT who received treosulfan\u2010based conditioning. Risk of bias was assessed using the Newcastle\u2013Ottawa Scale. Sixteen retrospective studies met inclusion criteria. Three studies evaluated sex hormone replacement therapy, and none of the patients receiving treosulfan required it. Treosulfan use was associated with significantly less gonadal toxicity compared to busulfan in several cohorts. Non\u2010gonadal endocrine or non\u2010endocrine late effects were reported mostly in single cohorts with no significant differences compared to busulfan. In conclusion, treosulfan\u2010based conditioning appears to have a meaningfully lower risk to gonadal dysfunction compared to busulfan, most prominently in patients with nonmalignant diagnoses and in females. No significant differences were observed for non\u2010gonadal late effects, albeit data remain limited.<\/jats:p>","DOI":"10.1002\/1545-5017.70652","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:33:25Z","timestamp":1789050805000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late Endocrine and Organ Toxicities After Treosulfan\u2010Based Conditioning in Pediatric Hematopoietic Cell Transplantation: A Systematic Review"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8296-6412","authenticated-orcid":false,"given":"Takuto","family":"Takahashi","sequence":"first","affiliation":[{"name":"Pediatric Stem Cell Transplantation, Boston Children's Dana\u2010Farber Cancer and Blood Disorders Center  Boston Massachusetts 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